Endotension is defined as which of the following?

• A. Sac distension with detectable endoleak
• B. Sac distension without detectable endoleak
• C. Sac rupture with pressure increase
• D. Sac shrinkage without aneurysm sac enlargement

Answer: (B)

Endotension occurs when the aneurysm sac continues to enlarge or remains pressurized after EVAR, but no endoleak is detected on imaging. The key feature is sac distension without a detectable leak feeding the sac. This differentiates it from true endoleaks, where imaging shows a leak and ongoing sac pressurization. It also differs from rupture, which is an acute emergency with sac rupture and pressure rise, and from sac shrinkage, which indicates improvement. In practice, endotension means the sac is still being pressurized despite no visible leak, so careful follow-up and sometimes further imaging or intervention are considered if the sac keeps growing.